Which RA treatment can help reverse joint damage?

Hello,

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I read your query and understand your concern.

I am deeply concerned about your worries, and I would like to explain the treatment options available.

In patients with rheumatoid arthritis, hydroxychloroquine is recommended for initial treatment in those with low disease activity.

1. Methotrexate is recommended for the initial treatment of patients with rheumatoid arthritis and moderate or high disease activity.

2. Rheumatoid arthritis treatment should be targeted according to a standardized disease activity scale.

3. In patients with rheumatoid arthritis who do not achieve low disease activity with Methotrexate, triple therapy with the addition of Sulfasalazine and Hydroxychloroquine is as effective as adding a biologic or targeted synthetic medication, although the response may be slower.

Disease-modifying antirheumatic drugs (DMARDs) are key in treating rheumatoid arthritis, and timely initiation can prevent joint damage. Although the multiple classes of DMARDs can make treatment decisions challenging, family physicians often prescribe these medications. DMARDs are categorized into conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs). Table 1 lists DMARDs approved for rheumatoid arthritis treatment. The American College of Rheumatology (ACR) has published updated guidelines focused solely on the medical treatment of rheumatoid arthritis.

Conventional Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs):

1. Hydroxychloroquine.

2. Sulfasalazine.

3. Methotrexate.

Biologic Disease-Modifying Antirheumatic Drugs (bDMARDs):

1. Adalimumab.

2. Infliximab.

3. Golimumab.

4. Etanercept.

For low disease activity (see Editor's Note for a measurement scale), consider initial treatment with Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Methotrexate, or Leflunomide (Arava) in this order. Hydroxychloroquine is better tolerated and has a better risk profile than the others. Sulfasalazine is recommended over methotrexate and leflunomide because it causes less immunosuppression. Methotrexate is recommended over Leflunomide because of its lower cost and better dosing flexibility.

For moderate to high disease activity, Methotrexate is the best initial treatment for rheumatoid arthritis. Methotrexate has stronger evidence of disease-modifying activity than other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), such as Hydroxychloroquine and Sulfasalazine. Although some biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) show evidence of better outcomes, Methotrexate is safe, effective, and has convenient dosing at low cost. Combination therapy is not recommended for initial treatment, as it is unnecessary for many patients and carries higher toxicity and cost.

You should consult with:

1. A multidisciplinary team for advice.

2. A consultant rheumatologist.

3. A consultant radiologist.

4. Physiotherapy.

5. A psychiatrist and psychotherapist.

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